US · guidance
CMS Pub. 100-18, ch. 12, § 10.2
Employer/Union Group Health Plan Sponsorship of Employer/Union- Only Group Waiver Plans (EGWPs)
As stated above, all EGWPs must restrict enrollment to employer/union group health plan Part
D eligible retirees and/or their Part D eligible spouses and dependents (hereinafter referred to
as “Part D eligibles”). The final benefit packages of “800 series” EGWPs are typically
developed through private contractual negotiations between the PDP sponsor and
employer/union group health plan sponsors of employment-based retiree coverage.
CMS has issued specific guidance waiving or modifying a number of Part D requirements that
apply to these two kinds of PDPs which are detailed below. However, Direct Contract and
“800 series” EGWPs must comply with all Part D requirements unless those requirements
have been specifically waived or modified.
History
(Rev.6, Issued: 11-07-08, Effective/Implementation: 11-07-08)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- iom-2026-09-17
- Content hash
2e6b764a568bdd188916db2003c186083e98d38f4d7b781175f6ac1dea636f69
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